Putting a price tag on contacting your medical specialist

So-called concierge medicine — doctors asking their patients to pay an extra fee just to remain under their care — has been around for a while.

It's an offensive idea, but I get it, especially when it comes to family practitioners who look after a patient's general well-being. The medical marketplace has room for both Corollas and Cadillacs.

Yet when it comes to medical specialists, such as cardiologists, things seem different.

"You never know when you'll need to reach your cardiologist," said Mike Oppenheim, 73, who was diagnosed as having a faulty heart valve several years ago. He'll need surgery at some point to fix it.

"I have a really good cardiologist at Pacific Heart Institute in Santa Monica," Oppenheim told me. "I'm getting the best care possible."

From now on, though, he'll have to pay a fee of as much as $7,500 a year — on top of his normal healthcare costs — if he wants to get in touch with his heart doctor by phone or email and receive top-notch care.

"I'm really upset about this," Oppenheim said. "They're just trying to make more money off of me."

A specialist, by definition, is a doctor whose care is required because of an acute problem that goes beyond the routine ministrations of a family practitioner. A specialist is your go-to medical pro when you have a condition that requires an up-close-and-personal form of healthcare.

Yet Pacific Heart Institute recently informed patients of its nine cardiologists that it's introducing an Enhanced Access Agreement that offers three levels of treatment in return for three levels of annual fees.

The institute's Select level costs an extra $500 a year. For that sum, patients will receive "priority appointments" for certain treatments, such as pacemaker maintenance, and "prompt notification of non-urgent test results."

Presumably, if you don't pay the extra money, you'll get your pacemaker adjusted at their convenience, and word of your test results will arrive in a less-than-timely manner.

I'm sorry, but for people with a heart problem, you'd think every diagnostic test is a priority. Moreover, since when is it considered a premium service to be able to reach your doctor by email, especially if you have a chronic condition?

The institute's top-drawer Concierge service runs $7,500 a year and provides everything the other levels offer, as well as 24-hour pager, email and cellphone access to your doctor and "emergency night and weekend availability of your personal cardiologist."

I spoke with Oppenheim's cardiologist, Dr. Richard Wright, who acknowledged that a doctor at his practice will always be available if a patient has an emergency.

"But if you want me, and it's my weekend off, that's now purchasable," he said. "What we're telling patients is that if you want additional access, that's an option."

From a purely dollars-and-cents perspective, Wright makes a case for premium levels of healthcare. Many of his patients are covered by Medicare, he said, and the federal insurance program has lower reimbursement rates than many private insurance plans.

It's not economically feasible, Wright said, for him and other doctors at his practice to take every patient call or respond to every email. In many cases, he said, nurses or nurse practitioners can just as easily handle these communications.

But if a patient wants to pay extra for a higher level of access, Wright said, then that possibility should be available.

"This is a mechanism for the doctor-patient relationship to survive," he said.

Or, put another way, it's a mechanism for wealthier patients to receive the level of care all patients deserve — and for everyone else to make do with whatever is left.

I have Type 1 diabetes and see an endocrinologist on a regular basis. I've had to call or email him more times than I can count to help deal with various issues.

I'd be just as outraged as Oppenheim if that level of care cost me potentially thousands of dollars more a year.

I'd also surely do a poorer job of managing my condition without my specialist's readily available assistance, which would be bad news for me, bad news for my insurer and bad news for all other ratepayers whose premiums depend on the sick not getting too sick.

I don't blame doctors like Wright for finding financial opportunities amid the chaos of our wildly dysfunctional healthcare system. As he put it, this is a service that some of his practice's thousands of patients will welcome and happily pay for.

But not all of them. Oppenheim said he'll start shopping around for a new cardiologist. He told me he can't stomach the idea of having to pay extra just to get some attention from the person helping keep him alive.